Attitudes of optimism toward death, existential thinking, and psychological well-being among chronic care specialists and acute care specialists

ABSTRACT This study tried to explore the level of wellbeing of practicing doctors in the two cities of India - Pune and Mumbai, as a function of the type of specialist care they provide (chronic care versus acute care). Chronic care is characteristically long term, has poor prognosis and aims to palliate rather than cure. Acute care typically lasts for three to six months and/or may easy spiral to fatal in minutes, and it generally aims to cure. The types of cases and casualties these doctors see at work are bound to affect their wellbeing and influence their view of life as well as death and nudge them to ponder about what greater meaning their lives hold. Through their hectic and stressful routines, doctors are known to have poor health behaviours and self-care patterns. The changes in the workplace due to the evolution of the healthcare industry pose new obstacles in care delivery and subsequently, affect job satisfaction. Various other factors may lead to dissonance. Studies have shown that the mental health of doctors does influence their service to patients as well as the treatment outcomes. The feelings of inadequacy and uncertainty regarding the management of dying patients, leading to counterproductive behaviours affecting care. The doctor's level of optimism is known to influence the treatment decisions and adherence in their patients, especially during dilemmas around experimental treatment and bleak prognosis. As the doctors juggle the personal and professional demands of their profession, the status of their psychological wellbeing can determine the maintenance of their morale and motivation to keep serving their cause. A healthy and driven workforce is essential in the healthcare sector at global to local level, in order to achieve the global Sustainable Development Goals, set by the WHO (2015). vi Looking at the doctor as the part and product of the very society he/she serves is necessary. Identifying their unique challenges helps towards building a support system for the medical community. This cross-sectional study was conducted on a sample of N = 120 (n chronic = 60, n acute = 60). The participating doctors responded to four standardized questionnaires that tapped their orientation towards life (optimism) and death, their psychological wellbeing, and the overall way they perceive meaning in their life (existential thinking). The participants responded to some open-ended questions in the personal data sheet. These responses were analysed for themes along with the narrative analysis of one doctor from each care category, whose psychological wellbeing score lay above the 90th percentile high. All the specialities were not represented in this purposive sample. Great hesitation to participate in the study was observed by the researcher, during the data collection phase. The two care specialities did not show any significant differences in all except one of the studied factors. The chronic care specialists had significantly higher positive relationships than the acute care group. Further qualitative probes revealed that similar level of wellbeing could be achieved despite of varied personal goals and priorities, by simply finding strategies to achieve them despite the situation one was in. Although the hypotheses were unsupported, this study provided a snapshot of the status of practicing Indian doctors' level of optimism, attitude towards death, level of existential thinking and psychological wellbeing. Thus, contributing to bridging the gap that exists due to the dearth of literature in this area. The limitations as well as the implications of the study were stated. Suggestions for further work at the level of inquiry and intervention were put forth. A preliminary, brief self-care module specific to the medical community was proposed.